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Going on ADs, what is the safest?

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superM1

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Sep 30, 2010
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So, without going into too much background, I am going to have to go on some antidepressants. I have a history of mdma, opiate, and alcohol use, but nothing overly severe... I can't say whether its drug induced or not, but its definitely clinical.

Being in the US, what I'm prescribed is usually dictated by big pharma, but I should have some leeway in alternate suggestions.

What is the safest antidepressant that I WILL be able to get off of in the near future without withdrawal problems, and what alters my brain chemistry the least.

SSRIs are the most commonly prescribed out here, but it seems like these are a lifelong obligation. 5HT receptors will be permanently, or near permanently downregulated? How can one ever get off of them.

MAOIs/TCAs - pretty harsh side effect profile.

Aside from SSRIs, the others also affect different neurotransmitters, are there any thoughts on how to classify a particular type of depression to a specific neurotransmitter? Or is this a game of trial and error?
 
It's not as cut and dry as you're trying to make it. Depression is a loose term, kinda like "pain", and as such is easily misinterpreted. It seems you're quite worried about side effects and/or NT dysregulation, and might want to see if a good ol' fashioned pro/con list would even warrant your use of an antidepressant to begin with.

That said, maybe something from the Tri/Tetra-CA family might be suitable.. amitriptyline is pretty common short term, without much risk of permanent changes. (I'm not a licensed Doctor >_>)

- GL & Happy Pharming :D
 
Talking about disruption of a single neurotransmitter is silly. The brain is an unbelievably complex system, and even if there was a problem with the levels of a single neurotransmitter, your brain would almost certainly adapt as if there wasn't a problem.

There are certainly biological underpinnings to depression, and SSRIs are a bit better than placebo (I think...), but drugs that have a wider range of activity seem to work better. Drugs like Venlafaxine and Duloxetine are frequently better, but at least the former has much worse withdrawal syndromes for a small portion of patients.

MAOI's don't have a harsh side effect profile- at least those I tried didn't- but they are definitely more dangerous than SSRI's. Patients on MAOIs have to be extremely careful about the medications they take and what they eat. With Emsam (transdermal selegiline), though, at least the food bit can be avoided.

Personally, if your doctor will consider it, I'd ask about low dose oral selegiline or tranylcypromine. I've never taken the latter, but from what I've read, it seems very good.
 
For severe depression, SSRIs/SNRIs/Wellbutrin.

For mild to moderate depression, sugar pills.

This is healthy living stuff
 
Ham made some excellent points.

If your doctor is resistant to the MAOI's he suggested (which wouldn't surprise me due to the dangerous interactions), his suggestion of duloxetine is a good one. I've heard (and witnessed) the horror stories of venlafaxine withdrawal and at least to this point, haven't heard the same claims made about duloxetine. I wouldn't say there is definitely not any discontinuation syndrome, but as long as you taper properly, its nothing you should be overly concerned about.

This is true of most medicines in general. There are no psych meds that will necessitate life-long adherence. With gradual tapers and perhaps supplementation, discontinuation can virtually always be done relatively painlessly.

I don't want to derail your thread, but AD's are not the only option so don't limit yourself to this treatment... exercise, counseling, many lifestyle changes and more can be as or more effective.
 
Cane2theLeft beat me to it: don't go on antidepressants until you've tried 2 straight weeks of 30min strenuous aerobic exercise every day, and are very sure you're still just as depressed.

SSRIs essentially enact the same long-term changes in CNS function that regular exercise does, with more side effects and less benefits body-wide. SSRIs are not the most fun drugs to quit, but SSNRIs (Venlafaxine and Duloxetine) have far harsher withdrawals, even if you miss only one dose.

I don't recommend MAOIs except in hospitalized / institutionalized patients with major depression, whose diets and medications can be tightly controlled. Very few doctors will prescribe them to outpatients, because the risks when inadvertently mixed with the wrong foods or drugs are too great. I'd administer a single dose of ketamine every month to an inpatient with refractory major depression before I'd put them on an MAOI.

TCAs affect a more dramatic change than SSRIs, but the side effects, especially the sleepiness and constipation, get annoying.

Bupropion (Wellbutrin) is probably the best tolerated. It may or may not work for you. It's the one I'd try first, though, if minimal side effects and safety were top priorities.
 
I'd like to reiterate what Cane and MDAO said about first trying regular exercise, before any kind of pharmacological intervention.

Also, I agree that Wellbutrin seems to be one of the best-tolerated anti-depressants on the market at this point in time BUT of course it is extremely subjective.
superM1, if you have any suicidal ideation going on, Wellbutrin can actually exacerbate suicidal thoughts at first, so that is something to be very wary of.

Have a chat with your doctor and see what they suggest first, then think about it for a week or so and do some more research before making a decision.
 
^ True. Bupropion is the LAST thing you want to be on if you have bipolar depression. It exacerbates the mania, which makes the depression (the crash from the mania) crushingly unbearable. Make sure your doc sees no evidence of any manic or hypomanic episodes in your past before he scripts you this.
 
I took zoloft for a few days once and I hated it. It made me feel so weird. Like a zombie or a robot. Don't take that shit, find the root of your problem and face it. Those drugs are nothing but trouble.
 
^^Try the Niacin, B6, B12, 5HTP, Eating healthier, sun exposure, environmental adjustments anything else first if you have doubts about AD's.
I find it weird that SSRI's are condisered to have a lower side effect profile cause I had some horrific sfx's on them. The older TCA's and Trazodone types were not so bad to deal with but for some clinical bullshit reason they should be worse. But in the end I'm still depressed still WDing for benzos which I started using with an SSRI to deal with sfx. There is a website called paxilprogress out there and you can read about some really shitty and long lasting wd's from that shit--almost as bad as benzos.
I don't think AD's are for you and you'll feel better without an added risk I think. Really try the above vitamins etc. and maybe some deep breathing exercises or treat yourself to something fun like a new video game or DVD you've been wanting to get.
 
^ Seriously, if TCAs did the job better than SSRIs for you and you can document that, you have no medical conditions that contraindicate their use, and you state that you understand the risks of TCAs, there's no reason you shouldn't be scripted a TCA. They're not particularly safe drugs, but they're no poisons.
 
So I've gone on a regimen of eating healthy and working out, been working through it for the last year. I'm feeling kind of low on energy, and have some sleep issues as well though, which make it difficult.

I've also been working through a few periods of alcohol use and abuse. I've used MDMA as well, last year maybe 5 times total. Not to the abuse level, but just thought I should share.

Daily I take piracetam+choline, fish oil, b100, multivites, ALA. I've tried St. Johns Wort as well based on some recs, but it doesn't seem to be doing much (@ around 900mg-1200mg/day).

What I need is something to get me out of this slump that I feel that I'm in. I've moderated the drinking, but I've lost a lot of my motivation, drive, and general happiness that I once had. I don't want to be on it more than a few months.

What looks interesting based on this post, and others, is Buproprin(Wellbutrin) and maybe Mirtazapine. Emsam (a transdermal MAOI) seems like an option as well. I'm going to explore these with my physician, but any feedback on those that have tried is appreciated.
 
Ultimately, it just comes down to what works for you. There isn't a standard rubric for how well any of these work and as far as I'm aware, they haven't determined generally why one drug works well for one person while doing fuck all for someone else exhibiting essentially the same symptoms.

Given there was probably some reason you've been drawn to abusing drugs and alcohol and that's somehow tied in to the slump you're experiencing now, perhaps finding someone you can talk to and help you work through this all with would be beneficial... this can take a lot of forms between individual or group counseling, seeing a therapist, support groups, and so on.

*If* there are issues that lead to all of this that you need to work through, exercise and SSRI's might not be sufficient to get past them.

Obviously I can't know your history and I'm not saying you need therapy or anything at all, I'm not in a position to make that call, but its something to consider that could be very beneficial and probably won't hurt to explore.
 
^^^I think I've read that no SSRI can top the benefits of the older TCAs if even match them in clinical trials. They do make you foggy and dry you out but I had the shakes, sweats, anxiety, nausea, and insomnia from the SSRIs. Doctors are quick to prescribe low dose Elavil for pain these days though.
 
^ that really is my fear. I've gone so long thinking these things are evil, but looking at the last year or two, I've been progressively declining into a worse and worse state, even while trying the talking therapy and avoiding using pharms.

maybe slightly strangely, the one thing that picked me up a bit was the few times of MDMA use last year. i didn't really get much of the post usage depression, instead it gave me some motivation and kept me going.
 
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